| NPI | 1700037090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW 003894) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: SC 9086 - CP) |
| Enumeration Date | 2008-10-05 |
| Last Update Date | 2008-10-05 |