| NPI | 1275139339 |
|---|---|
| Former Name | JACOB MICHAEL KELLY |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10694506-3502) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 171M00000X Case Manager/Care Coordinator (Licence: UT 10694506-3502) | |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2023-03-20 |