| NPI | 1669116240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 255855) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| 1041S0200X Social Worker, School (Licence: KY 255855) | |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2022-04-21 |