| NPI | 1770008203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW022630) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 12407203-3501) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2203543) | |
| Enumeration Date | 2017-08-05 |
| Last Update Date | 2022-04-08 |