| NPI | 1255875282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006135) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW006423) |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2024-03-29 |