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 |