| NPI | 1376138149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW008783) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW009671) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2024-01-01 |