| NPI | 1801159108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017319) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW10855) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2012-06-21 |