| NPI | 1700172624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW016586) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 32959) |
| 1041C0700X Social Worker, Clinical (Licence: WI 11724123) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2024-06-20 |