| NPI | 1609961366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC01432900) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 035020-1) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2011-04-27 |