| NPI | 1316327232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 107870) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 09705) |
| 104100000X Social Worker | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2025-05-12 |