| NPI | 1356678056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 108276) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I1200397) |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2023-08-24 |