| NPI | 1972752897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05401700) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05482100) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2024-11-05 |