| NPI | 1659882553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW019606) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WV DP00945180) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2019-04-15 |