| NPI | 1689136095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021552) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW234278) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2023-04-01 |