| NPI | 1396617924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 109959) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136927TELE) |
| 104100000X Social Worker (Licence: NJ 44SL06623600) | |
| 1041C0700X Social Worker, Clinical (Licence: FL TPSW6449) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06608700) | |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2026-02-08 |