| NPI | 1902007792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R035038) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 1041C0700X Social Worker, Clinical (Licence: NY 035038) | |
| 1041C0700X Social Worker, Clinical (Licence: NY R035038-1) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2023-03-28 |