| NPI | 1508096033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C006770) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW016573) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2022-02-09 |