| NPI | 1013514371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 256416) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 253457) |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2024-05-15 |