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 |