| NPI | 1891046462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 085984) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 8640) |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2022-07-21 |