| NPI | 1821170630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0000471) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA cw013457) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2022-11-10 |