| NPI | 1689095200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05609400) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05808100) |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2023-07-03 |