| NPI | 1699406785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 102742) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09933219) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06674300) | |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2026-07-09 |