| NPI | 1609324300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL05387000) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R053762-1) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2016-09-12 |