| NPI | 1982652368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05365500) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL SW7668) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2012-06-08 |