| NPI | 1164309969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW027546) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW142961) |
| Enumeration Date | 2025-08-21 |
| Last Update Date | 2026-08-03 |