| NPI | 1225879943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW025150) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW139493) |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2025-07-08 |