| NPI | 1881958726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW024792) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904007972) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2025-09-06 |