NPI | 1942835327 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW023248) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA CW023248) |
Enumeration Date | 2020-03-06 |
Last Update Date | 2022-12-30 |