| NPI | 1073674776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 14749) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC04533100) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2022-09-27 |