| NPI | 1124629555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06272600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 098408-01) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2026-03-10 |