| NPI | 1740600162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 08756) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05558000) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2015-10-02 |