| NPI | 1619159621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001222) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05333700) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2023-04-27 |