| NPI | 1164613014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017079) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 23948) |
| 104100000X Social Worker (Licence: PA SW128639) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2011-10-03 |