| NPI | 1629708516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 116165) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 102259) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2026-03-08 |