| NPI | 1780929992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 085533-1) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05783900) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2019-08-20 |