| NPI | 1558962738 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 098861-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 110961) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2024-12-02 |