| NPI | 1306016761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05389000) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 0766861) |
| Enumeration Date | 2008-03-01 |
| Last Update Date | 2024-04-05 |