| NPI | 1104846575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 804) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN LSW0000000611) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-05-06 |