| NPI | 1538380084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW016253) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R055302-1) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2012-02-22 |