| NPI | 1396617924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 109959) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06623600) |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2026-01-20 |