| NPI | 1982927414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017006) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW127178) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2014-03-19 |