| NPI | 1770681900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R027896-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ SC 07460) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-07-21 |