| NPI | 1184070336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW020838) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06170900) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2024-01-03 |