| NPI | 1568080430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW009780) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P014580) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2026-02-11 |