| NPI | 1922508175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-4583) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 253146) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2020-09-14 |