| NPI | 1801252960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121126) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW018732) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2022-07-26 |