| NPI | 1033632096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C8834) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MS M8834) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06186500) | |
| 1041C0700X Social Worker, Clinical (Licence: AL 5201C) | |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2024-05-01 |