| NPI | 1154818128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05910300) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44sl06307100) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2020-03-16 |