| NPI | 1871063784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091628-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 102721-1) |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2022-04-25 |