| NPI | 1093273625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05867500) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06231600) |
| Enumeration Date | 2019-03-02 |
| Last Update Date | 2021-07-28 |