| NPI | 1235200163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05567800) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05406100) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2014-02-15 |