| NPI | 1518158377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017308) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA sw126251) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2017-11-27 |