| NPI | 1306975560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3399) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 4875) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2010-09-20 |