| NPI | 1255966875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2304774) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 16223) |
| 104100000X Social Worker (Licence: OH I.2304774) | |
| 1041C0700X Social Worker, Clinical (Licence: KY 257926) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 09015601) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904015363) | |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2023-12-20 |