| NPI | 1396376299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06111900) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06351900) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2022-11-08 |