| NPI | 1639961048 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 100217) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 113172) |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2025-05-30 |