| NPI | 1770019119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 090694-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 099455-1) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2024-09-11 |