| NPI | 1962520916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS LSCSW 1532) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MO LCSW 0004247) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2014-09-18 |