| NPI | 1699055970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006718) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 078443-1) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2021-04-01 |