| NPI | 1457825259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW028267) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA SW134378) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2023-09-05 |