| NPI | 1861670283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SCO5800000) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW122788) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2021-07-12 |