| NPI | 1609036524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW003153) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC003852) |
| 1041C0700X Social Worker, Clinical (Licence: GA LPC003852) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2020-02-05 |