| NPI | 1194346858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087356) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 91959) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2026-01-05 |