| NPI | 1982940961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R084381) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 087148) |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2025-04-16 |