| NPI | 1538303367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY R034622-1) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NJ 44SC00035700) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2013-04-27 |