| NPI | 1952884660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: NY 100099) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 098511) |
| Enumeration Date | 2018-09-09 |
| Last Update Date | 2025-03-26 |