| NPI | 1275886871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083737) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05653800) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2018-08-24 |