| NPI | 1043591183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW005485) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 9094) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2023-06-23 |