| NPI | 1790212660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015714) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: NY 104384) | |
| 104100000X Social Worker | |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2023-03-02 |