| NPI | 1174097158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2507364) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S1700299) |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2025-11-10 |