| NPI | 1679082424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 24757) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW021182) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-07-28 |