| NPI | 1336579952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006615) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| 251S00000X | |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2020-07-21 |