| NPI | 1790936599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SC05919000) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW126856) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2022-11-29 |