| NPI | 1578132486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL06615100) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SL06615100) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2021-06-24 |