| NPI | 1366434045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW-001015-L) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW-001051-L) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2010-05-04 |