| NPI | 1538577143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW020030) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 15555) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2019-07-22 |