| NPI | 1134267859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003451) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO LCSW570) |
| 1041C0700X Social Worker Clinical (Licence: FL SW 7207) | |
| 1041C0700X Social Worker Clinical (Licence: GA CSW003860) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2011-04-06 |