| NPI | 1467008995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 256403) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 254242) |
| 104100000X Social Worker (Licence: IN 33009331A) | |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2025-07-24 |