| NPI | 1275805764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05609500) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 083929) |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2016-01-21 |