| NPI | 1982300547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 121175-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL06889400) |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2024-06-07 |