| NPI | 1033557137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05541800) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 28127) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2015-10-18 |