| NPI | 1275423907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 099160) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05463500) |
| 1041S0200X Social Worker School | |
| Enumeration Date | 2025-07-04 |
| Last Update Date | 2025-07-06 |