| NPI | 1376017590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05718800) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW019428) |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2019-01-22 |