| NPI | 1295849974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 252148) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34001721A) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2020-09-18 |