| NPI | 1780050625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 254654) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KY 252567) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2020-02-23 |