| NPI | 1124720552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 118928) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW138277) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2023-03-20 |