| NPI | 1750724100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 085207) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05850200) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2022-11-07 |