| NPI | 1306260740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 4076) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 6541) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2015-07-20 |