| NPI | 1043857253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006926) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 33026) |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2025-05-07 |