| NPI | 1902924798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW015341) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA CW015341) |
| 106H00000X Marriage & Family Therapist (Licence: PA CW015341) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2020-01-07 |