| NPI | 1396100079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW131414) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC002446) |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2023-02-08 |