| NPI | 1932631512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50081045) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW022393) |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2022-08-03 |