| NPI | 1336578046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW018791) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA SW130518) |
| Enumeration Date | 2013-11-03 |
| Last Update Date | 2021-04-01 |