| NPI | 1851593982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC04609600) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC04609600) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2012-05-22 |