| NPI | 1295725547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R047570) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00654900) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2020-02-05 |