| NPI | 1235684747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC01492200) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2019-03-08 |