| NPI | 1871255711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 122379) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 104100000X Social Worker (Licence: NY P117125) | |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2023-12-13 |