| NPI | 1790120723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL06000000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 560564) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2023-10-03 |