| NPI | 1124483318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW132895) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06088800) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2015-12-15 |