| NPI | 1720561608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05955700) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09927244) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2021-12-23 |