| NPI | 1528490877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW018657) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05928700) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2024-09-02 |