| NPI | 1124625108 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 097453) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 110475) |
| Enumeration Date | 2020-10-03 |
| Last Update Date | 2024-08-13 |