| NPI | 1639246085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 1446) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO 0992797) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2025-04-30 |