| NPI | 1831683606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021294) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06100000) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2002248) | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2025-09-02 |