| NPI | 1316441314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090787) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 102532) |
| 104100000X Social Worker (Licence: NJ 44SL06401700) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2021-03-02 |