| NPI | 1699151225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW006854) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MO 2017032173) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2025-07-22 |