| NPI | 1922375906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017802) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker (Licence: PA SW129595) | |
| Enumeration Date | 2011-11-19 |
| Last Update Date | 2015-06-18 |