| NPI | 1639363369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW001450E) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA CW015981) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2008-09-24 |