| NPI | 1669190419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q3-0000252) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW139293) |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-08-18 |