| NPI | 1356739916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05811200) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 092422) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2021-02-10 |