| NPI | 1225526411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05961100) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06222000) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2022-11-15 |