| NPI | 1568010221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096219) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 109586) |
| 104100000X Social Worker (Licence: NJ 44SL06570900) | |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2024-05-04 |