| NPI | 1114015245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: 44SC00077100) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 445C00077100) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2018-05-30 |