| NPI | 1245677483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW005335) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C008289) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2022-04-22 |