| NPI | 1952869588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05870200) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW020331) |
| Enumeration Date | 2019-03-02 |
| Last Update Date | 2020-02-08 |