| NPI | 1851677868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 4047) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34006794A) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2017-03-16 |