| NPI | 1396933578 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05584400) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 16632) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2014-10-08 |