| NPI | 1588984926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017030) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 034816) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05488400) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2020-08-24 |