| NPI | 1639320252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05467500) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05521200) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2024-01-10 |