| NPI | 1366885808 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083778-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW019148) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2018-12-21 |