| NPI | 1104428705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW008115) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 65981) |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2022-06-21 |