| NPI | 1174020747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 88441) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.1801158) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2025-11-25 |