| NPI | 1265984314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 086451) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW022727) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2024-01-18 |