| NPI | 1023322823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05573800) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 076606) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2022-01-18 |