| NPI | 1063191393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 120055) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06996300) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2024-11-18 |