| NPI | 1790153971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093615-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06196100) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2025-10-29 |