| NPI | 1518178185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW020857) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW125684) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2021-06-09 |