| NPI | 1366888612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I1502417-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001219) |
| 1041C0700X Social Worker, Clinical (Licence: NE 962) | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2022-06-06 |