| NPI | 1386324572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 120845) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 7828) |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2026-07-13 |