| NPI | 1972371649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06349500) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06725700) |
| Enumeration Date | 2023-12-12 |
| Last Update Date | 2024-06-20 |