NPI | 1992711568 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW012233) |
Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: PA CW012233) |
Enumeration Date | 2006-08-01 |
Last Update Date | 2007-07-08 |