| NPI | 1184278681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW023081) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05938500) |
| 1041C0700X Social Worker, Clinical (Licence: TX 110554) | |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2025-05-22 |