| NPI | 1346239621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC04937500) |
| Additional Taxonomies | 1041S0200X Social Worker School |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2007-07-08 |