| NPI | 1801599261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW025354) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA 44SC06482700) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2026-01-14 |