| NPI | 1407728306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 12317101) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW141907) |
| Enumeration Date | 2025-09-19 |
| Last Update Date | 2026-05-01 |