| NPI | 1598382210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093986) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06044000) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2024-02-29 |