| NPI | 1043543663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc05185600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R055664) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2019-01-10 |