| NPI | 1679650733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 072663) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05405700) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2011-01-12 |