| NPI | 1063173706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 113504-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL06749200) |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2022-01-05 |