| NPI | 1497102032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021067) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW133316) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 9575) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2021-07-29 |