| NPI | 1295473197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL06758400) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06758400) |
| Enumeration Date | 2022-05-22 |
| Last Update Date | 2022-05-22 |