| NPI | 1205924602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MD 04938) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA CW013713) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |