| NPI | 1356160022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL06719200) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 102839) |
| 104100000X Social Worker (Licence: NY 120518) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06545800) | |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2026-05-05 |