| NPI | 1255913794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW008567) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL TPSW2888) |
| 1041C0700X Social Worker Clinical (Licence: SC TLS365CP) | |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2023-08-14 |