| NPI | 1609988971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW005701L) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-05-24 |