| NPI | 1275942609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3917) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 3917) |
| 171M00000X Case Manager/Care Coordinator (Licence: KY 3917) | |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2019-09-30 |