| NPI | 1225550676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW134255) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW021498) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2021-12-10 |