| NPI | 1003545013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: GA MSW011595) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA MSW011595) |
| 104100000X Social Worker (Licence: VA 0903004043) | |
| 104100000X Social Worker (Licence: MI 6851114226) | |
| 1041C0700X Social Worker, Clinical (Licence: GA MSW011595) | |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2024-05-30 |