| NPI | 1326601709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 055623) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC06059400) |
| Enumeration Date | 2019-04-21 |
| Last Update Date | 2026-09-18 |