| NPI | 1154199354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C016618) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW023930) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2024-01-18 |