| NPI | 1205296134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-41119) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1302240) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.1700189) | |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2025-08-08 |