| NPI | 1528651668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW023803) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW136831) |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2023-07-14 |