| NPI | 1306508015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 256927) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 253415) |
| 1041C0700X Social Worker, Clinical (Licence: IN 34010001A) | |
| Enumeration Date | 2021-10-10 |
| Last Update Date | 2023-01-16 |