| NPI | 1538256912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY PR0188581) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC01291400) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2025-12-02 |