| NPI | 1396470324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 098010) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 125506) |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2024-12-01 |