| NPI | 1073921516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 252481) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 7054) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2019-05-31 |