| NPI | 1821542093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2102560) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM C-09556) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2023-12-19 |