| NPI | 1245314517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW017724) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 067971-1) |
| 1041C0700X Social Worker Clinical (Licence: NY 075778) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2016-06-30 |