| NPI | 1053208264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC06499700) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2025-06-20 |
| Last Update Date | 2025-06-20 |