| NPI | 1659495257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 104489) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I0006014) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2023-10-06 |