| NPI | 1629619283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW021442) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW135922) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2021-06-11 |