| NPI | 1508836156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2203683-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW003273) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-09-14 |