| NPI | 1619207214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW006827L) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW006837L) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2010-01-04 |