| NPI | 1760839146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 086445) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 15208) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44sco6131100) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2025-12-22 |