| NPI | 1598211617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05864000) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 098451) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2019-08-26 |