| NPI | 1992569511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 098130) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 108550-01) |
| Enumeration Date | 2024-02-13 |
| Last Update Date | 2024-08-05 |