| NPI | 1245381672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW008789L) |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: PA SW008789L) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2007-07-08 |