| 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 |