| NPI | 1467628123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA SW126555) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW126555) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2008-08-20 |