| NPI | 1790256279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096156) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 105136-1) |
| 106H00000X Marriage & Family Therapist (Licence: NY 001662) | |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2023-11-28 |