| NPI | 1962788307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0000759) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC05252400) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2018-08-10 |