| NPI | 1558619387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 5060) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 6384) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2018-03-08 |