| NPI | 1275917296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087410) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06030100) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2026-10-07 |