| NPI | 1053940098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA LCSW94331) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW019071) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2020-04-02 |