| NPI | 1639550650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05789100) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2018-05-14 |