| NPI | 1467564997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3485) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WV DP00939800) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-07-10 |