| NPI | 1407242480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW020403) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 104100000X Social Worker (Licence: PA SW132214) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2022-07-18 |