| NPI | 1124500244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00287300) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 036268) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2019-03-13 |