| NPI | 1952830549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL06214400) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06214400) |
| 104100000X Social Worker (Licence: NY 095569-1) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2021-05-05 |