| NPI | 1023360104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006152) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 8375190-3502) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2022-07-21 |