| NPI | 1982184628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 092417) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 103777) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2023-09-28 |