NPI | 1861526584 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA LCSW 000147) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA LMFT 000297) |
Enumeration Date | 2007-03-15 |
Last Update Date | 2007-07-08 |