| NPI | 1104391671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL06398900) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 103880-1) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-10-10 |