| NPI | 1447801774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096926) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06347900) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW026178) | |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2025-07-24 |