| NPI | 1982350302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW025920) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA CW025920) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2025-05-29 |