| NPI | 1467170548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 05890) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 9607) |
| Enumeration Date | 2022-08-16 |
| Last Update Date | 2022-11-06 |