| NPI | 1821630476 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 107607-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: 107607-01) |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2023-04-11 |