| NPI | 1396709614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW012895) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA CW012895) |
| 104100000X Social Worker (Licence: PA CW012895) | |
| 101Y00000X Counselor (Licence: PA CW012895) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2008-04-30 |