| NPI | 1326414079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05634600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW005272) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2016-06-04 |