| NPI | 1447947890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW008557) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC04696500) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-04-18 |