| NPI | 1215576509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.1802049) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW129784) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2026-04-16 |