| NPI | 1720156805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW019774) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50077950) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904006346) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2019-11-19 |