| NPI | 1609233261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW005367) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 118481) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2020-08-06 |