| NPI | 1013611144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW024032) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW137520) |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-10-17 |