| NPI | 1811545627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL05587600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0012005) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2022-05-31 |