| 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) |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2024-05-15 |