| NPI | 1588974836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW020036) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WV BP00943159) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2018-11-20 |