| NPI | 1902962483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 073142) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW011175L) |
| 1041C0700X Social Worker, Clinical (Licence: NY 079448) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2019-02-25 |