| NPI | 1609272996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc05738200) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 086195) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2019-01-30 |