| NPI | 1780353953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 097760) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 110318-01) |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2024-09-03 |