| NPI | 1871708776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW018692) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC04509600) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2019-07-16 |