| NPI | 1821532698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06167600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 089486) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2025-08-20 |