| NPI | 1902289846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 126360) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 00-1977) |
| 104100000X Social Worker (Licence: PA SW142465) | |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2025-04-16 |