| NPI | 1316248545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY P17652) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ SC 10222) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2010-11-04 |