| NPI | 1356877229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW019489) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW109626) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2026-08-04 |