| NPI | 1184105827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 097486) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06390000) |
| 1041C0700X Social Worker, Clinical (Licence: FL TPSW5946) | |
| 1041C0700X Social Worker, Clinical (Licence: PA CW021766) | |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2026-08-23 |