| NPI | 1740792340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW023345) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06189300) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC18703) | |
| Enumeration Date | 2017-11-04 |
| Last Update Date | 2023-07-12 |