| NPI | 1609339126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 102701) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06118700) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2026-01-08 |