| NPI | 1891223061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090373-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 100602) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-08-12 |