| NPI | 1396086963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05586500) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05686000) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2014-07-02 |