| NPI | 1396024170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05458000) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R029792-1) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2011-08-10 |