| NPI | 1225677412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW022703) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW135435) |
| Enumeration Date | 2020-01-05 |
| Last Update Date | 2022-05-23 |