| NPI | 1801295472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05591600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 73074744) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2017-02-08 |