| NPI | 1194117408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: PA 25548989) |
| Additional Taxonomies | 251B00000X Case Management (Licence: PA 25548989) |
| 251E00000X Home Health (Licence: PA 25548989) | |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2015-02-23 |