| NPI | 1528734308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc05595900) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 070090) |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2021-08-20 |