| NPI | 1114219730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SW05327400) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SW05327400) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2022-02-07 |