| NPI | 1760563571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 11640) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc04505200) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2018-03-13 |