| NPI | 1932473113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW006447) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW017519) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW14355) | |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2024-01-09 |