| NPI | 1881328144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 259386) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 256847) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2025-03-12 |