| NPI | 1194054494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05525500) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05631200) |
| 104100000X Social Worker (Licence: NY 080449) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 080449) | |
| Enumeration Date | 2009-12-15 |
| Last Update Date | 2018-03-17 |