| NPI | 1457568032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW008456L) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW5480) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2010-07-01 |