| NPI | 1912858713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 11502) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 086111) |
| Enumeration Date | 2026-02-06 |
| Last Update Date | 2026-02-06 |