| NPI | 1023595832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06482500) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 097324) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2025-05-15 |