| NPI | 1376217497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 259705) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 7164) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2025-02-05 |