| NPI | 1114760899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 123679) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL07136800) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2025-08-04 |