| NPI | 1043560824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 81903) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW019031) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2020-06-09 |