| NPI | 1760958839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW023027) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW132474) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2022-10-10 |