| NPI | 1962716332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05430800) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 073545-1) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2010-08-31 |