| NPI | 1104213347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW018358) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 006030) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2015-04-24 |