| NPI | 1124185152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW016085) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW005402E) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2013-06-21 |