| NPI | 1659989366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA sw130668) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW021986) |
| 1041C0700X Social Worker, Clinical (Licence: AK 112509) | |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2022-05-19 |