| NPI | 1396308771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MA 124185) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW020237) |
| Enumeration Date | 2019-04-21 |
| Last Update Date | 2021-10-06 |