| NPI | 1558624510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW004343) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL TPSW857) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2023-12-26 |