| NPI | 1043925894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06355700) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 44SL06763200) |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2024-07-03 |