| NPI | 1902661051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC06309100) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW024619) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-10-04 |