| NPI | 1861968968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096398) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 103575-1) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2025-02-04 |