| NPI | 1255897518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05974800) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06262500) |
| 104100000X Social Worker (Licence: PA SW133566) | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2021-02-01 |