| NPI | 1609263052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 3796C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW009851L) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2017-03-01 |