| NPI | 1205316635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C015956) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW021665) | |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2024-10-29 |