| NPI | 1518794155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 259867) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34011411A) |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2026-03-11 |