| NPI | 1407507924 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06344900) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 226532) |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2024-07-24 |