| NPI | 1811657893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW138846) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: PA CW024909) | |
| Enumeration Date | 2021-12-18 |
| Last Update Date | 2024-12-26 |