| NPI | 1891198164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 087395-1) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2024-02-26 |