| NPI | 1275191306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.0027743) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6802073603) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2023-11-08 |