| NPI | 1700252061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006038) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW22850) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2024-04-24 |