| NPI | 1952774697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN 8017) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW133317) |
| 104100000X Social Worker (Licence: TN LSW0000010371) | |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2022-01-21 |