| NPI | 1245338524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00179400) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY PR020016-1) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |