| NPI | 1346106812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL07355600) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 129903) |
| Enumeration Date | 2025-12-29 |
| Last Update Date | 2025-12-29 |