| NPI | 1659781953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05741800) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 086536) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2019-05-13 |