| NPI | 1518442250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006841) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW007450) |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2021-11-02 |