| NPI | 1639979909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 125199) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL07183100) |
| Enumeration Date | 2025-03-17 |
| Last Update Date | 2025-03-17 |