| NPI | 1962590422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW012683) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA CW012683) |
| 101Y00000X Counselor (Licence: PA CW012683) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-10-18 |