| NPI | 1154949071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 092798) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 104446-1) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2022-02-09 |