| NPI | 1427464676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085142-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW023775) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2023-07-12 |