| NPI | 1790337590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096585) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 104745) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2024-03-26 |