| NPI | 1619613528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL06701300) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06701300) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2022-06-04 |