| NPI | 1225331523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW017884) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW128221) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2015-02-04 |