| NPI | 1437709086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006660) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA CSW006660) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2024-11-05 |