| NPI | 1083394993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 107204) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2023-07-27 |