| NPI | 1922516889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 115700) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06183100) |
| Enumeration Date | 2018-01-12 |
| Last Update Date | 2023-07-06 |