| NPI | 1265968671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 094189) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW132101) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2017-05-04 |