| NPI | 1912540105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 255294) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY KYCSW253369) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2020-10-27 |