| NPI | 1972519957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05918100) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 088945) |
| 1041C0700X Social Worker, Clinical (Licence: OH I6048-SUPV) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-04-19 |