| NPI | 1821873381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY LCSW00001250) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2025-11-19 |