| NPI | 1003307745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW025142) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW136438) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2024-10-21 |