| NPI | 1649728221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00938486) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I0008182SUPV) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2021-12-20 |