| NPI | 1750774741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05923700) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 257898) |
| 1041C0700X Social Worker, Clinical (Licence: NY 095201-01) | |
| Enumeration Date | 2015-03-14 |
| Last Update Date | 2023-09-28 |