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 |