| NPI | 1407104276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC00173500) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 040601) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2012-08-27 |