| NPI | 1366820532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05787800) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06000700) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2022-07-06 |