| NPI | 1639150584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA 1431) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 586) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2024-10-29 |