| NPI | 1528444858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA sw130059) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA sw130059) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA sw130059) | |
| 101YM0800X Counselor, Mental Health (Licence: PA sw130059) | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2017-04-19 |