NPI | 1154980092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW023265) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WV DP00947028) |
Enumeration Date | 2019-06-12 |
Last Update Date | 2024-10-25 |