| NPI | 1851993034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904012424) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06291100) |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2024-01-23 |