| NPI | 1316291883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008996) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05565400) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2019-10-09 |