| NPI | 1285935916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50080049) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW017945) |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2014-12-30 |