| NPI | 1922422948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS LSCSW2439) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO LCSW001606) |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2016-06-23 |