| NPI | 1215794656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 32072) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2304887) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149.024895) | |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2025-11-26 |