| NPI | 1154109023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096058) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 098883) |
| 104100000X Social Worker (Licence: VA 0903002898) | |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2023-09-20 |