| NPI | 1063545036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00673000) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ 37FI00111300) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |