| NPI | 1659843407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 253724) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 253724) |
| 101YM0800X Counselor, Mental Health (Licence: KY 253724) | |
| 171M00000X Case Manager/Care Coordinator (Licence: KY 253724) | |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2024-05-11 |