| NPI | 1366919623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 255508) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 253296) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2021-02-10 |