| NPI | 1366164352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06384100) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2024-09-06 |