| NPI | 1922617190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 088349) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06173900) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2023-10-05 |