| NPI | 1174124341 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 097195) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 105395) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2024-06-20 |