| NPI | 1306420005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2305054-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL TPSW5669) |
| 1041C0700X Social Worker, Clinical (Licence: TX 117049) | |
| Enumeration Date | 2021-05-08 |
| Last Update Date | 2025-10-28 |