| NPI | 1881006161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001465) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW131956) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2022-07-21 |