| NPI | 1164247029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW024682) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200002701) |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2024-11-18 |