| NPI | 1386996031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW018792) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW129394) |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2021-01-24 |