| NPI | 1720459480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KY 3196) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 3196) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2016-04-27 |