| NPI | 1114660081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc01482500) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 084734-1) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2022-04-18 |