| NPI | 1578050332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006148) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05681900) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2023-12-04 |