| NPI | 1073999512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05947000) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW132495) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW021410) | |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2024-05-28 |