| NPI | 1831253343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 077134) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 13956) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW13956) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2023-05-14 |