| NPI | 1619699600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL06846600) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW139363) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2025-01-16 |