| NPI | 1720223118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05363300) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09932660) |
| Enumeration Date | 2008-12-13 |
| Last Update Date | 2025-12-17 |