| NPI | 1811365364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL06101400) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05818000) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2019-07-02 |