| NPI | 1982029310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05569800) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 73081059) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2014-02-21 |