| NPI | 1124772827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL06632800) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL06632800) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NJ 44SL06632800) | |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2022-02-10 |