| NPI | 1023264066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 009813) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA SW133914) |
| 1041C0700X Social Worker Clinical (Licence: NJ 44SL06216200) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2021-09-27 |