| NPI | 1962649798 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW017823) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2021-08-10 |