| NPI | 1023028974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW016517) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 073544) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2015-11-29 |