| NPI | 1134764335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 6712) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 6712) |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2019-11-12 |