| 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 |