| NPI | 1396932281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW003802) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA CSW003802) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801061643) | |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2018-07-30 |