| NPI | 1467333682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 127435) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL07322900) |
| Enumeration Date | 2025-09-12 |
| Last Update Date | 2025-09-12 |