| NPI | 1235439860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05540800) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: NJ 792613) |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2020-04-13 |