| NPI | 1891873196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ PC01637) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ R0300151-1) |
| 1041C0700X Social Worker, Clinical (Licence: NJ SC00729) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-08 |