| NPI | 1568519866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I-007136) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801088367) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2024-05-06 |