| NPI | 1912576331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096989) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY p103817) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2025-05-14 |