| NPI | 1194467555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06240200) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06663900) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2023-08-02 |