| NPI | 1962572750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW013309) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW 11673) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2014-06-03 |