| NPI | 1912475831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093633) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC0615200) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2023-07-11 |