| NPI | 1174860431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083703) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05606100) | |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2022-11-22 |