| NPI | 1295207199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW020528) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW132809) |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2019-04-30 |