| NPI | 1316685480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 257203) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 256821) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-09-07 |