| NPI | 1457859001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1800786) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 61803) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926912) | |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2021-06-26 |