| NPI | 1538836879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001743) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 085359-01) |
| 171M00000X Case Manager/Care Coordinator (Licence: 4244775) | |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2021-08-25 |