| NPI | 1396498820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 17140) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW009215) |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2025-01-14 |