NPI | 1811489370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW019585) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 28712) |
Enumeration Date | 2018-05-31 |
Last Update Date | 2025-01-02 |