| NPI | 1063990604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW018559) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05597500) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2019-07-17 |