| NPI | 1497744650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00152200) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ 37FI00070700) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2014-11-13 |