| NPI | 1609399146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 259856) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 20435) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2025-01-29 |