| NPI | 1750513487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L4098) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW-0006646-L) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2013-12-17 |