| NPI | 1952449803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW014343) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NJ 44SC04583900) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2012-05-01 |