| NPI | 1659715811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017658) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA CW017658) |
| 101YM0800X Counselor, Mental Health (Licence: PA CW017658) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2013-04-18 |