| NPI | 1760804231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 1099-3582C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW005194) |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2023-12-12 |