| NPI | 1477852770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW127933) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA LW017488) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2012-11-19 |