| NPI | 1487360608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 112273-01) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 112273-01) |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2023-01-31 |