| NPI | 1841845831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 252425) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IN 34009812A) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2024-02-19 |