| NPI | 1891683520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093007) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW03445) |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2025-06-24 |