| NPI | 1336039866 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 127537) | 
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL07273600) | 
| Enumeration Date | 2025-07-07 | 
| Last Update Date | 2025-07-07 |