| NPI | 1336892553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc06394100) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06757400) |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2024-11-01 |