| NPI | 1952872459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114201) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 093661) |
| 252Y00000X Early Intervention Provider Agency (Licence: NY 103026) | |
| Enumeration Date | 2018-12-09 |
| Last Update Date | 2023-08-16 |