| NPI | 1386413318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW139660) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 14849) |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2024-01-02 |