| NPI | 1528219532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ n44sc04780800) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 050466) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2008-10-08 |