| NPI | 1760877724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: DE Q1-0001549) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 094314-1) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2023-09-13 |