| NPI | 1871079673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 088574) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 089728) |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2019-07-30 |