| NPI | 1902266091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 090537-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09928240) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2026-07-13 |