| NPI | 1508309865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021238) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW133817) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2022-07-19 |