| NPI | 1750739421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 7692) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2017-04-11 |