| NPI | 1215440375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 091805) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 102105-1) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2023-04-04 |