| NPI | 1194085274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW020434) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C008993) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2020-09-10 |