| NPI | 1760585798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 506) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34002233A) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2024-10-01 |