| NPI | 1336792175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021982) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW133235) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2022-07-26 |