| NPI | 1851319032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05233000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC0523300) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-04-07 |