| NPI | 1396800348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05205900) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW014891) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2012-04-05 |