| NPI | 1164946364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021454) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW134306) |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2025-07-08 |