| NPI | 1821213729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00098600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R013380-1) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2017-09-18 |