| NPI | 1538399415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 1558) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34004579A) |
| Enumeration Date | 2009-07-25 |
| Last Update Date | 2024-04-16 |