| NPI | 1922519834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW18288) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 102102) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2026-01-05 |