| NPI | 1053761379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 096468) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06157200) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2024-02-28 |