| NPI | 1881164564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 088489) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 096878-1) |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2019-07-01 |