| NPI | 1992472732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 089820) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: 089820) |
| 104100000X Social Worker (Licence: 089820) | |
| Enumeration Date | 2021-08-28 |
| Last Update Date | 2023-03-15 |