| NPI | 1699782326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3087) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 3824) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2023-02-23 |