| NPI | 1851675110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 3540) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: GA 6217) |
| 1041C0700X Social Worker Clinical (Licence: TN 5268) | |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2023-09-13 |