| NPI | 1740534817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW018638) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801093378) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2023-11-02 |