| NPI | 1235621434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021303) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA 134132) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2026-07-16 |