| NPI | 1831672914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093058-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 104728-1) |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2025-11-10 |