| NPI | 1689977225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 14769) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05431900) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2018-09-20 |