| NPI | 1659743219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05802400) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL06110700) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2022-08-09 |