| NPI | 1609065838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC01367900) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SC005612E) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2007-10-24 |