| NPI | 1346375946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021928) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 81627) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2025-08-20 |