| NPI | 1063883544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW018726) |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 13231) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2015-10-09 |