| NPI | 1215212642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW005989) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 17210) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2017-01-22 |