| NPI | 1528385101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05503500) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NJ 44SL05514900) |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2012-07-11 |