| NPI | 1891228375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091316) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 098740-1) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2022-11-09 |