| NPI | 1467702746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3992) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 6364) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2019-05-09 |