| NPI | 1982950119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA CW014359) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW014359) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2019-08-28 |