| NPI | 1518322833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1801160) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 55248) |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2019-07-01 |