| NPI | 1710902069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA CW014837) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA CW014837) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-07-15 |