| NPI | 1366143257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 125638) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P120634) |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2024-11-04 |