| NPI | 1265948079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021046) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW134804) |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2020-02-07 |