| NPI | 1750970786 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 108042) |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2024-05-01 |