NPI | 1801430145 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 100719) |
Additional Taxonomies | 104100000X Social Worker (Licence: NY 113802) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-10-30 |
Last Update Date | 2025-08-14 |