| NPI | 1053097436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06256200) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 097865-01) |
| 1041C0700X Social Worker, Clinical (Licence: MO 2023010568) | |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2026-08-15 |