| NPI | 1710533575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06193700) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NJ 44SL06378300) |
| 1041S0200X Social Worker, School (Licence: NJ 44SC06193700) | |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2023-05-15 |