| NPI | 1760757546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW018875) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW127956) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2019-06-04 |