| NPI | 1396552410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 122734) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 122734) |
| Enumeration Date | 2024-12-12 |
| Last Update Date | 2024-12-16 |