| NPI | 1558510552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW019047) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA CW019047) |
| 104100000X Social Worker | |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2022-08-04 |