| NPI | 1457808354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 253917) |
| Additional Taxonomies | 104100000X Social Worker (Licence: 252195) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2020-08-24 |