| NPI | 1942711130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05967300) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 37LC00343300) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2023-07-17 |