| NPI | 1750936407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 099510) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 8528) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2025-11-03 |