| NPI | 1508882309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY KY-322) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34004246A) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2008-01-02 |