| NPI | 1023396637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05353700) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW016853) |
| Enumeration Date | 2011-07-31 |
| Last Update Date | 2014-12-01 |