| NPI | 1073959250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO 09925007) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05605400) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2021-03-31 |