| NPI | 1316034374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW016621) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW01851L) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2020-04-03 |