| NPI | 1831768563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-19390) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW019789) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2022-11-04 |