| NPI | 1285999714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-3986) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW128277) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2019-03-22 |