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 |