| NPI | 1710248091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017941) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW128747) |
| 104100000X Social Worker (Licence: PA CW017941) | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2024-11-02 |