| NPI | 1346869872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 108895-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904016665) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2024-09-10 |