| NPI | 1144920802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 19529) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 085872) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-03-09 |