| NPI | 1558399428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34003229A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY KY-852) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-07-08 |