| NPI | 1790532794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 127864) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL07307000) |
| 104100000X Social Worker (Licence: NJ 44SL07307000) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 127864) | |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2025-09-12 |