| NPI | 1285878231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL05150000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: None) |
| 174400000X Specialist (Licence: NJ S-2219) | |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2009-04-21 |