| NPI | 1821586975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 104533) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 094675) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2023-01-28 |