| NPI | 1528628609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW010530) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 12110) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2026-08-07 |