| NPI | 1477528982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW003798) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL SW7880) |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2009-01-26 |