| NPI | 1689157844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 117520) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 1032026) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2023-12-19 |