| NPI | 1386318632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00946785) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2608759) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2026-09-22 |