| NPI | 1053972687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW143996) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA SW143996) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2026-04-13 |