| NPI | 1538703368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 095499) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-39110) |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2024-03-11 |