| NPI | 1902983893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 076217) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 068549) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09931416) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-11-17 |