| 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 |