| NPI | 1255996435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05860700) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW020244) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2025-01-03 |