| NPI | 1700534377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083745) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW9424) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2025-05-06 |