| NPI | 1114018603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R036723-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00354600) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-12-01 |