| NPI | 1861018699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA SW009286L) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW009286L) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-07-02 |