| NPI | 1780775882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00144100) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ 37FI00135600) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2008-09-07 |