| NPI | 1265720775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW004708) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 13593) |
| 1041C0700X Social Worker, Clinical (Licence: TX 37302) | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2024-08-20 |