| NPI | 1558860981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091356) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 102400-1) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW021949) | |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2023-04-26 |