| NPI | 1073924304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc05779700) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 087480) |
| 1041C0700X Social Worker, Clinical (Licence: PA cw020118) | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2022-12-14 |