| NPI | 1396707899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R030904) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC04566700) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2025-04-30 |