| NPI | 1639508914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05554200) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 083970) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2021-07-21 |