| NPI | 1518339878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW006880) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: SC 11381) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2024-01-18 |