| NPI | 1821353491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW019425) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SW124529) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2024-11-21 |