| NPI | 1639887557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW024885) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 117661) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06409400) | |
| Enumeration Date | 2022-11-09 |
| Last Update Date | 2024-12-10 |