| NPI | 1841072915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW21437) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA LCSW119178) |
| 1041S0200X Social Worker School (Licence: NJ 44SC06336100) | |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2024-05-10 |