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 |