| NPI | 1720139140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY KY-1123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34003371A) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2016-12-12 |