| NPI | 1093396566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06193800) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SL06606200) |
| 104100000X Social Worker (Licence: NJ 44SL06606200) | |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2023-03-30 |