| NPI | 1003405135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2405104) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WV DP00945318) |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2026-04-07 |