| NPI | 1013237775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 76152) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2203579) |
| 1041C0700X Social Worker, Clinical (Licence: MO 2022007802) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904013796) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2026-01-24 |