| NPI | 1174065114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 253405) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 6494) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2021-09-01 |