| NPI | 1093898603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C008194) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW013476) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2018-06-28 |