| NPI | 1356978746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05945600) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06405000) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2021-02-25 |