| NPI | 1770230625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0004538-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW20135) |
| 1041C0700X Social Worker, Clinical (Licence: KY 257062) | |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2022-09-13 |