| NPI | 1104377589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 099484-1) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NJ 44SL06157300) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2018-06-25 |