| NPI | 1811343841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 125120) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 0996466) |
| 1041C0700X Social Worker, Clinical (Licence: NY 093229) | |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2022-10-23 |