| NPI | 1730169913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0007335-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH 1.0007335) |
| 1041C0700X Social Worker, Clinical (Licence: NM SWB-2023-0525) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 98193) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2024-11-08 |