| NPI | 1033467006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 252396) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 166043) |
| Enumeration Date | 2012-08-26 |
| Last Update Date | 2019-05-09 |