| NPI | 1023214004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA cw014966) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA CW014966) |
| 104100000X Social Worker (Licence: PA CW014966) | |
| 106H00000X Marriage & Family Therapist (Licence: PA CW014966) | |
| 101YP2500X Counselor, Professional (Licence: PA CW014966) | |
| 101Y00000X Counselor (Licence: PA CW014966) | |
| 1041S0200X Social Worker, School (Licence: PA CW014966) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2012-12-13 |