| NPI | 1831822246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06150000) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 092592) |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2023-01-18 |