| NPI | 1457095291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA SW136591) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SW136591) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2022-05-13 |