| NPI | 1073778361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 104100000X Social Worker |
| 101YM0800X Counselor Mental Health (Licence: PA BH1934) | |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2016-09-23 |