| NPI | 1407721962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R049841-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC24334) |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2025-10-06 |