| NPI | 1063741288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 19510) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA CW017502) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW017502) | |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2024-11-04 |