| NPI | 1255464517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW024309) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06341200) |
| 1041C0700X Social Worker, Clinical (Licence: IN 34004609) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2024-05-30 |