| NPI | 1982952263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW130829) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 104100000X Social Worker (Licence: VA 0903001982) | |
| Enumeration Date | 2012-08-17 |
| Last Update Date | 2013-10-08 |