| NPI | 1568530459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY KY1176) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34005140A) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-03-23 |