| NPI | 1043625395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC01431200) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 37FI00050300) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2014-06-25 |