| NPI | 1568837904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW024977) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 18744) |
| 1041C0700X Social Worker, Clinical (Licence: CA 95292) | |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2026-09-07 |