| NPI | 1598391112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW007864) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW009289) |
| Enumeration Date | 2020-03-15 |
| Last Update Date | 2022-03-15 |