| NPI | 1407524556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 101592) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2304266) |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2026-07-07 |