| NPI | 1922534817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015882) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 095689) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-05-05 |