| NPI | 1366464117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW025748) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R0317681) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-04-16 |