| NPI | 1316362221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 16031) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW130669) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW018924) | |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2025-07-29 |