| NPI | 1063952794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 099513) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L10316) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2025-04-18 |