| NPI | 1407285893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085688) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05878800) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2023-03-28 |