| NPI | 1386246965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW007597) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL SW17976) |
| 101Y00000X Counselor | |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2023-06-20 |