| NPI | 1205355930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 015263) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2025-08-04 |