| NPI | 1952887853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 0898667) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 096406-1) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2020-09-19 |