| NPI | 1902445810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 100182-01) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2019-12-26 |
| Last Update Date | 2025-05-28 |