NPI | 1689016008 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100602900) |
Additional Taxonomies | 104100000X Social Worker |
1041C0700X Social Worker, Clinical | |
Enumeration Date | 2013-07-26 |
Last Update Date | 2019-01-01 |