| NPI | 1700578671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 074151-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC04993900) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-05-22 |