| NPI | 1447616156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 253123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 7353) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2022-06-02 |