| NPI | 1811364805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087788) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 095418-1) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2021-05-24 |