| NPI | 1538616321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW020333) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW132502) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2023-06-22 |