| NPI | 1558729590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006477) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc05669600) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2020-01-06 |