| NPI | 1073636775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW14520) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 1041C0700X Social Worker Clinical (Licence: PA CW015626) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2022-07-21 |