| NPI | 1699948737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY LCSW00001131) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY LCSW00001131) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2025-09-23 |