| NPI | 1508261819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 252478) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 7093) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2017-03-23 |