| NPI | 1710692710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34010899A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 259720) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2506196) | |
| 1041C0700X Social Worker, Clinical (Licence: AL 5885C) | |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2025-09-12 |