| NPI | 1912375817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006739) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN LSW0000006235) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW11749) | |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2019-08-05 |