| NPI | 1184491714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 2410634) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC04867000) |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2023-12-04 |