| NPI | 1831515881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW020182) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA 127718) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2019-01-17 |