| NPI | 1578771515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA csw2397) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT 1589) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2013-10-11 |