| NPI | 1972276913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 272421) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 256340) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2025-10-06 |