NPI | 1760055511 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091423) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC20437) |
Enumeration Date | 2021-07-20 |
Last Update Date | 2025-07-25 |