| NPI | 1306591789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61440337) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2309125) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2023-09-01 |