| NPI | 1043367659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 253240) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN CSW0000006823) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2025-02-28 |