| NPI | 1497249544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091100) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 091100) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SL04975400) | |
| 1041C0700X Social Worker, Clinical (Licence: FL TPSW5143) | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2025-06-27 |