| NPI | 1609991470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00241100) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05250800) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |