| NPI | 1770798639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW004465) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA MSW004080) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2017-01-27 |