| NPI | 1053950097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW007442) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA MSW007491) |
| Enumeration Date | 2019-12-21 |
| Last Update Date | 2022-01-19 |