| NPI | 1073925798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 077337) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05487800) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2025-10-17 |