| NPI | 1174134803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 109376) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NY 1414031201) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2020-08-14 |