| NPI | 1861964744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW021613) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW131675) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2021-05-06 |