| NPI | 1306255781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-09216) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I-1501348-SUPV) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2022-11-01 |