| NPI | 1437133568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW000778L) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00078900) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2009-12-28 |