| NPI | 1568234870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA Cw025242) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW138766) |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-11-12 |