| NPI | 1063638732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW003770) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA 3770) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2025-01-03 |