| NPI | 1992789531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW012774) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: PA 04043671) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2023-09-08 |