| NPI | 1104482041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW008597) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: AL 4808C) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2023-07-18 |