| NPI | 1568183762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 118929) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW139720) |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2023-08-18 |