| NPI | 1013485119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW022900) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 130381) |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2023-01-30 |