| NPI | 1689268625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05968900) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 16485) |
| Enumeration Date | 2021-02-21 |
| Last Update Date | 2024-01-18 |