| NPI | 1124615364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 100522) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 110476-01) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2025-07-10 |