| NPI | 1013671957 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 097541) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 114380-01) |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2024-04-25 |