| NPI | 1902832116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS LSCSW1579) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO LCSW003266) |
| 1041C0700X Social Worker, Clinical (Licence: KS 1579) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2021-01-06 |