| NPI | 1174134803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 099708) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 109376) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2025-06-04 |