| NPI | 1992148415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 256194) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WV DP00944383) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2025-05-07 |