| NPI | 1548304769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017173) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA CW017173) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA CW017173) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2016-02-14 |