| NPI | 1730457854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C007525) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.0030847) |
| Enumeration Date | 2011-12-03 |
| Last Update Date | 2025-11-18 |