| 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 |