| NPI | 1104058247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44al05736600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 080857-1) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2011-11-16 |