NPI | 1235678467 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05657500) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924495) |
Enumeration Date | 2017-02-21 |
Last Update Date | 2019-02-13 |