| NPI | 1366865503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 13157) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05508300) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2022-05-08 |