| NPI | 1881961431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW012865) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL0539440) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2011-11-28 |