| NPI | 1134662570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05693400) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC5693400) |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2024-03-30 |