| NPI | 1619319902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 080949) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW019621) |
| Enumeration Date | 2013-07-27 |
| Last Update Date | 2024-02-27 |