| NPI | 1265966428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW024635) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL05905600) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2025-04-10 |