| NPI | 1669507125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW016062) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW013599L) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2021-06-28 |