| NPI | 1366966483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 091382) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 101156) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2025-08-26 |