| NPI | 1588065650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 092195) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05974000) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2014-09-09 |