| NPI | 1750149563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA SW137355) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL06611500) |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-07 |