| NPI | 1578883575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 252366) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 5642) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2018-08-14 |