| NPI | 1043801053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 112532) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT MSW.005636) |
| Enumeration Date | 2021-02-02 |
| Last Update Date | 2021-05-04 |