| NPI | 1366878084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE CW016737) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA SW128063) |
| 101YM0800X Counselor, Mental Health (Licence: DE CW016737) | |
| 1041C0700X Social Worker, Clinical (Licence: PA SW128063) | |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2016-10-21 |